HomeMy WebLinkAbout20090523.tiffRESOLUTION
RE: APPROVE AGREEMENT CONCERNING SURGICAL SERVICES AND AUTHORIZE
CHAIR TO SIGN - SURGICAL ASSOCIATES OF GREELEY, P.C.
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with an Agreement Concerning Surgical
Services between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Weld County Department of Public Health and
Environment, and Surgical Associates of Greeley, P.C., commencing January 1, 2009, and ending
January 1, 2010, with further terms and conditions being as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Agreement Concerning Surgical Services between the County of Weld,
State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf
of the Weld County Department of Public Health and Environment, and Surgical Associates of
Greeley, P.C., be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 2nd day of March, A.D., 2009.
BOARD OF C�O TY COMMISSIONERS
WELD C,(JUI�TY,(COLORADO
ATTEST:
Weld County Clerk to t
BY•
Deputy Clerk to the Board
APPROVED AS TO FORM:
frou Attor y
Date of signature.
am F. Garcia. Chair n
Le
ouglas
demache(, Pro-Tem
Se P. Conway
atbara Kirkmeyer J
David E. Long
a, C j --)/
2009-0523
HL0036
0347/08
at;
Wi�pc
COLORADO
Memorandum
TO: William F. Garcia, Chair
Board of County Comrtiisgipntrso
p ,: 2l
FROM: Mark E. Wallace, MD, MPH
Director, Department of Public Health
and Environment ,n k, //aA,
DATE: February 26, 2009
SUBJECT: Surgical Services Contract for
Women's Wellness Connection
Enclosed for Board review and approval is the contract between the Weld County Department of
Public Health and Environment (WCDPHE) and the Surgical Associates of Greeley PC. With
the approval of this contract, Surgical Associates of Greeley will see clients referred by
WCDPHE Women's Wellness Connection who are in need of specialist evaluation and indicated
diagnostics. Surgical Associates will use the approved Women's Wellness Connection fee
schedule. The contract period is Jan 1, 2009 through January 1, 2010 .
1 recommend your approval of this contract.
Enclosure
2009-0523
COLORADO
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 N 17TH AVE
GREELEY, CO 80631
WEBSITE: www.co.weld.co.us
ADMINISTRATION (970) 304-6410
FAX (970) 304-6412
PUBLIC HEALTH EDUCATION AND NURSING (970) 304-6420
FAX (970) 304-6416
ENVIRONMENTAL HEALTH SERVICES (970) 304-6415
FAX (970) 304-6411
January 9, 2009
Lisa Burton M.D.
Surgical Associates of Greeley P.C.
1800 15th street. Ste. 210
Greeley, CO 80631
Re: Surgical Services Agreement for Women's Wellness Connection clients
Dear Dr. Burton:
Thank you for your willingness to assist us with referrals from WWC. Enclosed are triplicate originals of the
above referenced Surgical Services Agreement between the Weld County Department of Public Health and
Environment and Surgical Associates of Greeley PC for signature by the appropriate individual.
Please return all three to me and once fully executed then we will return one to you.
I am more than happy to come and pick them up so that we can expedite the process.
Sincerely,
Mary Lloyd-Cumley R.N., N.P
Clinical Services Manager
Weld County Department of Public Health and Environment
1555 N. 17th Ave
Greeley, CO 80631
970-304-6420 extension 2302
AGREEMENT CONCERNING SURGICAL SERVICES
THIS AGREEMENT is made and entered into by and between Surgical Associates of
Greeley PC and Weld, State of Colorado, by and through the Board of County Commissioners of
Weld County, on behalf of the Weld County Department of Public Health and Environment
("WCDPHE").
BACKGROUND INFORMATION
WHEREAS, WCDPHE requires certain surgical services, to be provided to patients who
qualify for the Women's Wellness Connection program ("WWC"); and
WHEREAS, Surgical Associates of Greeley has the necessary credentials and the
appropriate personnel to provide the Services in the State of Colorado, and to provide such Services
to patients who qualify for the WWC program ("WWC patients");
WHEREAS, WCDPHE would like Surgical Associates to provide Services, and Surgical
Associates is willing and able to provide such Services to eligible WWC patients consistent with
the terms and conditions hereinafter set forth.
NOW THEREFORE, for and in consideration of the covenants, conditions, agreements, and
stipulations hereinafter expressed, the parties do hereby agree as follows:
1. Recitals. The above set forth recitals are hereby incorporated as though set forth herein
verbatim.
2. Term of Agreement. This Agreement shall be effective January 1, 2009, and continue
through January 1, 2010, unless sooner terminated pursuant to the provisions contained in this
Agreement. This Agreement may be renewed for additional one (1) year periods upon mutual
written agreement of the parties.
3. Termination of Agreement. Either party may terminate this Agreement with or without
cause upon thirty (30) days written notice to the other party, such notice to be given pursuant to the
provisions contained in this Agreement. If this Agreement is so terminated, WCDPHE shall pay
that compensation to Surgical Associates which duly reflects the amount not previously reimbursed
for actual Services rendered to WWC patients under the terms and provisions of this Agreement by
Surgical Associates during the term of this Agreement, and pursuant to the terms and provisions of
this Agreement.
4. Services to be Provided by WCDPHE. WCDPHE agrees to provide the following
services pursuant to this Agreement, concerning WCDPHE clients who are referred or authorized to
receive Services from Surgical Associates:
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(a) Referrals. All referrals and authorizations for Services to WWC patients will be
coordinated through WCDPHE and the WCDPHE designated coordinator. WCDPHE shall provide
all information necessary to ensure patients are identified correctly as being participants in the
WWC Program when presenting for Services at Surgical Associates.
(b) Eligibility for Services. WCDPHE will determine a patient's eligibility for
Services prior to referral of such patient to Surgical Associates. Surgical Associates will confirm
eligibility status with WCDPHE, in the event of any question concerning such status. In addition,
the parties acknowledge that the patients receiving Services have authorized WCDPHE to monitor
or audit the Services being provided to them by Surgical Associates.
(c) Vouchers. At the time of registration at Surgical Associates Facility and prior to
performing Services, Surgical Associates will require patients to present a WCDPHE WWC
voucher in substantially the form of Exhibit A, which is attached hereto and incorporated herein by
reference.
5. Compensation. In consideration for the Services to be provided by Surgical Associates as
set forth in this Agreement, WCDPHE agrees to pay Surgical Associates the following:
(a) Funding and Rates for Services. Within thirty (30) days of receipt of Surgical
Associates invoice, WCDPHE shall pay Surgical Associates for Services (as defined herein) in
accordance with the reimbursement rates set forth in the current WWC rate sheet attached hereto
and incorporated herein as Exhibit B. If the WWC rate sheet is modified at any time during the
term of this Agreement, WCDPHE shall notify Surgical Associates immediately of such change,
and in any case, no later than thirty (30) days after such change, giving Notice as provided for in
this Agreement.
(b) Billing. Surgical Associates will provide to WCDPHE on a monthly basis, a
summary of Services rendered to WWC patients referred or authorized by WCDPHE to receive
such Services. The summary will include the following information: patient name, date of birth,
and date of service. Surgical Associates will provide in a timely manner any additional information
which may be required by WCDPHE in processing the billing information.
(c) Request for Adjustment of Payment. Either party shall be entitled to request an
adjustment of payment if it notifies the other party in writing of the overpayment or underpayment
within ninety (90) days of such payment and provides documentation substantiating such claim.
Such requests for payment adjustment must be answered within thirty (30) calendar days of receipt.
(d) Paying Adjustments. If the parties determine that WCDPHE has underpaid
Surgical associates, WCDPHE shall pay the underpaid amount to Surgical Associates within
fourteen (14) calendar days of such determination. If the parties determine that WCDPHE has
overpaid Surgical Associates, Surgical associates shall reimburse WCDPHE for the overpayment
within fourteen (14) days of said determination.
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(e) Payment Final. Except for those payment disputes that have been submitted to a
court of law or in accordance with this section, all payments shall be final.
(f) No Offsets or Deductions without Permission. Take -backs, offsets, and
deductions, as commonly used in the health care industry, are expressly prohibited. In no event
shall WCDPHE offset overpayments against, or deduct overpayments from, any other payments it
owes to Surgical Associates unless Surgical Associates expressly permits WCDPHE to do so in
writing.
6. Surgical Associates Responsibilities. Surgical Associates agrees to provide the following
services and be responsible for the following:
(a) Services. Surgical Associates agrees to provide certain Surgical services as more
specifically set forth on the current WWC rate sheet, Exhibit B. Surgical Associates shall submit
invoices on a monthly basis to WCDPHE, 1555 North 17th Avenue, Greeley, Colorado 80631, for
Services provided under this Agreement.
(b) Timely Clinical Services Report. Surgical Associates shall use best efforts to
return a clinical services report within one (1) week of the date of service to allow WCDPHE to
report required information to the State of Colorado. Any disclosure of information will be in
compliance with federal and state law. In the event of a contradiction between this Agreement and
federal and state law, federal and state law shall govern the release of any confidential information.
(c) No Additional Fees Shall be Paid. Surgical Associates shall not bill additional fees
to the WWC patient for those Services covered under the approved WWC codes for the fiscal year
2008-2009.
7. Records. The relevant records of Surgical Associates shall be complete and available for
audit ninety (90) days after final payment for any Services provided pursuant to this Agreement,
and shall he retained and available for audit purposes for at least five (5) years after such final
payment. The parties agree to the additional following provisions concerning records:
(a) Medical Records. Medical records for the Services provided pursuant to this
Agreement will be maintained at Surgical Associates, but WCDPHE personnel will have access to
such files at all reasonable times during regular business hours.
(b) Financial Records. WCDPHE shall have access to the financial records kept by
Surgical Associates with respect to the Services provided by Surgical Associates pursuant to this
Agreement at all reasonable times during regular business hours.
(c ) Confidentiality. Each party agrees to keep any and all records and information
confidential, and to comply with the privacy obligations applicable to them under the Health
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Insurance Portability and Accountability Act of 1996 and the regulations issued pursuant thereto, as
amended (42 USC 1320d and 45 CFR 160.101, et. seq.) ("HIPAA") and to comply with all other
laws and regulations concerning the confidentiality of such records. The parties agree to execute a
Business Associate Agreement pursuant to HIPAA requirements, if such an agreement is indicated.
8. Errors, Acts, and Omissions.
(a) WCDPHE. WCDPHE agrees it shall be liable for any claims, costs and
expenses, arising from or out of any alleged negligent act or omission of WCDPHE or its agents or
employees in the performance or lack of performance of its obligations under this Agreement. This
section shall survive termination of this Agreement.
(b) Surgical Associates. Surgical Associates agrees it shall be liable for any claims,
costs and expenses, arising from or out of any alleged negligent act or omission of Surgical
Associates or its agents or employees in the performance or lack of performance of its obligations
under this Agreement. This section shall survive termination of this Agreement.
9. No Federal Exclusion. WCDPHE hereby represents and warrants that WCDPHE is not,
and at no time has been, excluded from participation in any federally funded health care program,
including Medicare and Medicaid. WCDPHE hereby agrees to immediately notify Surgical
Associates of any threatened, proposed, or actual sanction or exclusion from any federally funded
health care program, including Medicare and Medicaid. Such notice shall contain reasonably
sufficient information to allow Surgical Associates to determine the nature of any sanction. In the
event that WCDPHE is excluded from participation in any federally funded health care program
during the term of this Agreement, or if, at any time after the effective date of this Agreement, it is
determined that WCDPHE is in breach of this Section, this Agreement shall, as of the effective date
of such exclusion or breach, automatically terminate.
Surgical Associates hereby represents and warrants that Surgical Associates is not, and at no
time has been, excluded from participation in any federally funded health care program, including
Medicare and Medicaid. Surgical Associates hereby agrees to immediately notify WCDPHE of any
threatened, proposed, or actual sanction or exclusion from any federally funded health care
program, including Medicare and Medicaid. Such notice shall contain reasonably sufficient
information to allow Surgical Associates to determine the nature of any sanction. In the event that
Surgical Associates is excluded from participation in any federally funded health care program
during the term of this Agreement, or if, at any time after the effective date of this Agreement, it is
determined that Surgical Associates is in breach of this Section, this Agreement shall, as of the
effective date of such exclusion or breach, automatically terminate.
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10. General Provisions.
(a) Section Headings. The headings of sections in this Agreement are for reference
only and shall not affect the meaning of this Agreement.
(b) Parties' Relationship. The parties to this Agreement intend that the relationship
between them contemplated by this Agreement is that of independent entities working in mutual
cooperation. No employee, agent, or servant of one party shall be or shall be deemed to be an
employee, agent, or servant of another party to this Agreement.
(c) No Waiver of Immunities. Notwithstanding any other provision contained herein,
WCDPHE specifically does not waive any immunities to which it may be entitled by statute or
otherwise, including, without limitation, the Colorado Governmental Immunity Act.
(d) Non -Assignment. This Agreement shall not be assigned, delegated, or transferred
by either party without the prior written consent of the other party. Notwithstanding any provision
of this Agreement to the contrary, Surgical Associates shall have the right to assign or otherwise
transfer its interest under this Agreement to any "related entity." For the purposes of this section, a
related entity shall be deemed to include a parent or subsidiary of Surgical Associates, any entity
that acquires all or substantially all of Surgical Associates assets or operations relating to this
Agreement, and the surviving entity of any merger or consolidation involving Surgical Associates.
Any assignment to a related entity shall not require the consent or approval of WCDPHE in order to
be effective.
(e) Notices. Any notice or other communication provided for in this Agreement shall
be in writing and shall be served by personal delivery, confirmed facsimile, or by certified mail,
return receipt requested, postage prepaid, at the addresses set forth in this Agreement, until such
time as written notice of a change is received from the party wishing to make a change of address.
Any notice so mailed and any notice served by personal delivery or confirmed facsimile shall be
deemed delivered and effective on the date of delivery if the notice is personally served or served by
facsimile, or on the third business day following the date of mailing if the notice is mailed by
certified mail.
Surgical Associates of Greeley PC:
Surgical Associates of Greeley PC
1 800 15th Street 210
Greeley, Colorado 80631
WCDPHE: Weld County Department of Public Health And Environment
c/o Judy Nero
1555 N. 17th Avenue
Greeley, Colorado 80631
FAX: (970) 304-6412
(t)
No Waiver of Attorney -Client Privilege. Neither party waives the attorney -client,
5
the accountant -client, or any other legal privilege by virtue of this Agreement.
(g) Change in Law. If there is a change in any federal or state law, regulation or rule
that affects this Agreement or the activities of either party under this Agreement, or any change in
the judicial or administrative interpretation of any such law, regulation, or rule, and either party
reasonably believes in good faith that such change shall have a substantial adverse effect on such
party's business operations or its rights or obligations under this Agreement, then such party may,
upon written notice, require the other party to enter into good faith negotiations to renegotiate the
terms of this Agreement. If (a) the parties are unable to reach an agreement concerning the
modification of this Agreement within the earlier of (i) forty-five (45) days after the date of the
notice seeking renegotiation or (ii) the effective date of the change, or (b) the change is effective
immediately, then either party may immediately terminate this Agreement upon written notice of
such termination to the other party.
(h) Binding Effect. This Agreement shall be binding upon, and shall inure to the
benefit of, the parties hereto and their successors and permitted assignees.
(i) Unforeseen Circumstances. In the event that Surgical Associates does not have
proper facilities to treat patients or in the event of circumstances beyond their reasonable control
such as a major disaster, epidemic, war, complete or partial destruction of facilities, disability of a
significant number of personnel or significant labor disputes, Surgical Associates shall provide
health services to patients to the extent possible according to its best judgment or limitations of
such facilities and personnel as are then available, but Surgical associates shall have no liability or
obligation for delay or failure to provide or arrange for such services.
(j) Ethical Business Practices. WCDPHE and Surgical Associates understand and
agree that all obligations under this Agreement shall be conducted in accordance with all applicable
laws and regulations. In addition, WCDPHE and Surgical Associates understand and agree that all
business operations will be conducted in accordance with applicable business and ethical standards.
(k) Governing Law. This Agreement shall be governed under the laws of the State of
Colorado, and any relevant Federal law.
(I) Medical Practices. WCDPHE and Surgical Associates understand and agree that all
obligations concerning medical practices under this Agreement shall be conducted in accordance
with the applicable standards of care within the community.
(m) Confidential Information. During the term of this Agreement and at all times
thereafter, WCDPHE and Surgical Associates shall ensure that WCDPHE and Surgical Associates,
and their directors, officers, employees, contractors and agents hold the other party's Confidential
Information in the strictest confidence and in accordance with state and federal law. "Confidential
Information" shall include without limitation all information and records whether oral or written or
disclosed prior to or subsequent to the execution of this Agreement regarding the following:
6
the following: patients, utilization review, quality assessment, finances, volume of business,
methods of operation, trade secrets, contracts and prices and price -related information. To the
extent allowed by Law, each party shall return or destroy, as directed by the disclosing party, all
Confidential Information received from the other party following termination of this Agreement for
any reason. The parties agree that disclosure of a party's Confidential Information other than in
accordance with this Section or applicable federal or state Law shall cause irreparable injury to
such party, and that the injured party shall be entitled to injunctive relief to prevent the other party's
breach of this Section. Notwithstanding any provision contained herein to the contrary, Surgical
Associates acknowledges that WCDPHE is a department of Weld County Government, and as such,
is subject to the Colorado Open Records Act, which would most likely recognize this Agreement
and its accompanying records, among other things, as open records.
(n) Modification and Breach. This Agreement contains the entire Agreement and
understanding between the parties to this Agreement and supersedes any other agreements
concerning the subject matter of this transaction, whether oral or written. No modification,
amendment, novation, renewal, or other alteration of or to this Agreement and the attached exhibits
shall be deemed valid or of any force or effect whatsoever, unless mutually agreed upon in writing
by the undersigned parties. No breach of any term, provision, or clause of this Agreement shall be
deemed waived or excused, unless such waiver or consent shall be in writing and signed by the
party claimed to have waived or consented. Any consent by any party hereto, or waiver of, a breach
by any other party, whether express or implied, shall not constitute a consent to, waiver of, or
excuse for any other different or subsequent breach.
(o) Severability. If any term or condition of this Agreement shall be held to be invalid,
illegal, or unenforceable, this Agreement shall be construed and enforced without such a provision,
to the extent this Agreement is then capable of execution within the original intent of the parties.
(p) Funding. No portion of this Agreement shall be deemed to create an obligation on
the part of the County of Weld, State of Colorado, or WCDPHE to expend funds not otherwise
appropriated during the term of this Agreement.
(q) No Third Party Enforcement. No portion of this Agreement shall be deemed to
constitute a waiver of any immunities the parties or their officers or employees may possess, nor
shall any portion of this Agreement be deemed to have created a duty of care with respect to any
person not a party to this Agreement.
It is expressly understood and agreed that enforcement of the terms and conditions of this
Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the
undersigned parties, and nothing contained in this Agreement shall give or allow any claim or right
of action whatsoever by any other person not included in this Agreement. It is the express intention
of the undersigned parties that any entity other than the undersigned parties receiving Services or
benefits under this Agreement shall be deemed an incidental beneficiary only.
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(r) Conflict of Interest. No officer, member, director, or employee of WCDPHE or
Surgical Associates, and no member of their governing bodies shall have any pecuniary interest,
direct or indirect, in the approved Agreement or the proceeds thereof.
(s) Non -Exclusive Agreement. This Agreement is not exclusive. Accordingly,
either Surgical Associates or WCDPHE shall have the right to enter into one or more agreements
relating to the same or similar matters as are covered by this Agreement, and execution by either
party of such agreements shall not constitute a breach of this Agreement.
IN WITNESS WHEREOF, the parties have hereunto set their hands and seals on the
dates stated below.
WELD COUNTY DEPARTMENT OF
PUBLIC HEALTH AND ENVJRONMENT
Mark E. Wallace, M.D., MPH,
Director
SURGICAL ASSOCIATES OF GREELEY PC
By:
)a_& - � u - --1
Title
Date Date
BOARD OF COUNTY COMMISSIONERS ATTEST:
WELD COUNTY, COLORADO Weld County Clerk to
Chair William F. Garcia
MAR 0 2 2009
Date
8
By:
Deputy Clerk
67
tiervi;
COLORADO
DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT
1555 N. 17th Avenue
Greeley, CO 80631
WEBSITE: www.co.welcl.co.us
ADMINISTRATION: (970) 304-6410
FAX: (970) 304-6412
PUBLIC HEALTH EDUCATION & NURSING: (970) 304-6420
FAX: (970) 304-6416
ENVIRONMENTAL HEALTH SERVICES: (970) 304-6415
FAX: (970) 304-6411
Women's Wellness Connection
Consultation Voucher
This voucher is for women who qualify for and are enrolled in the Women's Wellness Connection Program.
Surgical Associates of Greeley
1800 15th Street Ste. 210, Greeley, CO 80631
(970) 352-8216
Patient's name:
Nombre de la paciente
Patient's date of birth:
Fecha de nacimiento
Consultation appt:
Fecha de la city
Surgical Associates of Greeley agrees to the Women's Wellness Connection rates, see rate sheet attached.
This voucher is to ensure proper billing of the named person, please send the bill to:
Weld County Department of Public Health
Attn: Adriana Chairez
1555 N. 17th Ave.
Greeley, CO 80631
If you have any questions, please call
Adriana Chairez @ (970) 304-6420 extension 2382
Exhibit A
MEDICARE RATES AND CPT CODES - June 2008
Women's Wellness Connection
Reimbursable Procedures for Fiscal Year 06/30/2008 - 06/29/2009
Page 1
Profe signal
Technical
Procedure
CPT CODE
GO RA7t
nt
.Component'
REENING PROCEDURES
Screening Mammogram Analog
77057
$ 82.17
$ 33.61
$ 48.56
AScreening Mammogram Digital
G0202
$ 133.03
$ 33.23
$99.80
Clinical Breast Exam (CBE)
99203
$ 45.11
Pelvic Exam
99203
$ 45.11
Conventional Pap Smear
88164
$ 14.76
Thin Prep (Liquid based) Pap
88142
$ 28.31
Pap with physician interpretation
88141
$ 24.58
AWWC will reimburse quarterly a capped rate of $12.71 per digital screening mammogram. Must be
documented in eCaST.
BREAST DIAGNOSTIC PROCEDURES
Imaain
Diagnostic Mammogram/Unilateral
77055
$ 81.90
$ 33.61
$ 48.29
Diagnostic Mammogram/Bilateral
77056
$ 103.45
$ 41.51
$ 61.94
Breast Ultrasound
76645
$ 84.32
$ 25.71
$ 58.61
Consult or Repeat CBE
Surgical consult/repeat CBE
Biopsy
Excisional Biops
99243
$ 121.06
Excision of breast lesion identified by: preop placement
of radiologic marker
19120
$ 375.38
OR
Excision of breast lesion
19125
$ 399.58
AND
Pre -op placement of needle loc wire
19290
$ 154.31
Pre -op placement of needle loc wire, radiologic
interpretation and supervision
77032
$ 65.85
$ 26.47
$ 39.38
Radiologic examination specimen
76098
$ 21.07
$ 7.52
$ 13.55
Biopsy inter•retation
88305
$ 102.38,
$ 35.90
$ 66.48
Stereotactic Core Biopsy
Breast bx, needle core, not using imaging
OR
19100 $ 126.55
Breast bx, incisional
19101
$ 287.81
AND
Stereotactic localization, each lesion, radiologic
supervision and interpretation
77031
$ 324.67
$ 76.04
$ 248.63
Radiologic examination specimen
76098
$ 21.07
$ 7.52
$ 13.55
Biopsy interpretation
88305
$ 102.38
$ 35.90
$ 66.48
# Maximum allowable reimbursement rate
Source: Centers for Medicare Services/Physician Fee Schedule, 2008:
*Preapproval from WWC required http://www.cros.hhs.gov/PFSlookup/02_PFSSearch.asp#TopOfPageMedicaid
MEDICARE RATES AND CPT CODES - June 2008
Women's Wellness Connection
Reimbursable Procedures for Fiscal Year 06/30/2008 - 06/29/2009
Page 2
Procedure
CPT CODE
CO RATE
Professional
Component
Technical
Component
U/S Guided Core Biopsy
Percutaneous, needle core, using imaging guidance I 19101 I $ 210.42 !
OR
Breast bx, incisional
19102
$ 287.81
AND
US Guidance for Cyst Aspiration, Radiologic Supervision
and Interpretation
76942
$ 175.52
$ 32.08
$ 143.44
Biopsy interpretation
88305
$ 102.38
$ 35.90
$ 66.48
Stereotactic Vacuum Assisted Biops
Automated vacuum assisted bx
19103
$ 544.94
Tissue marker placement
19295
$ 95.49
Post procedure mammogram
77055
$ 81.90
$ 33.61
$ 48.29
Stereotactic localization, each lesion, radiologic
supervision and interpretation
77031
$ 248.63
$ 76.04
$ 172.59
Radiologic examination specimen
76098
$ 21.07
$ 7.52
$ 13.55
Biopsy interpretation
88305
$102.38
$ 35.90
$ 66.48
Other Sampling
Cyst Aspiration
*Cyst Aspiration
19000
$ 104.93
*US Guidance for Cyst Aspiration, Radiologic Supervision
and Interpretation
76942
$ 175.52
$ 32.08
$ 143.44
FNA by Palpation
FNA without image guidance
Eval of FNA
10021
$ 128.36
88172
50.72
$ 29.14
$ 66.18
21.58
interpretation and Report of FNA
U/S Guided FNA
$ 64.79
FNA with image guidance
10022
$ 134.70
Eval of FNA
88172
$ 50.72
$ 29.14
$ 21.58
Interpretation and Report of FNA
88173
$ 130.97
$ 66.18
$ 64.79
*Total 31439/
Additional allowable procedures - please submit these procedures quarterly to WWC Data Manger
Breast biopsy interpretation with margins
88307
$ 201.51
$ 77.131 $ 124.38
Excisional Biopsy - addt'l lesion
19126
$ 141.88
Excisional Bx - addt'I lesion/ needle loc wire
19291
$ 66.78
*Aspiration of cyst, additional
19001
$ 24.74
Surg path, first tissue block, froz spec
88331
$ 86.53
$ 57.91
$ 28.62
Surg path, ea. Addt'l block
88332
$ 38.86
$ 28.76
$ 10.10
Anesthesia for procedures
00400
Supplies & materials not usually provided
99070
# Maximum allowable reimbursement rate
*Preapproval from WWC required
Source: Centers for Medicare Services/Physician Fee Schedule, 2008:
http://www.cros.hhs.gov/P F Siookup/02_P FSSearch.asp#TopOfPageMedicaid
MEDICARE RATES AND CPT CODES - June 2008
Women's Wellness Connection
Reimbursable Procedures for Fiscal Year 06/30/2008 - 06/29/2009
Page 3
Procedure
CPT CODE
COiRATE .
Professional
Component
: T clinical
Component
ERVICAL DIAGNOSTIC PROCEDURES
HPV Testing
87621
$ 49.04
GYN Consult
99243
$ 121.06
Colposcopy
Colposcopy without Biopsy
Colposcopy with Biopsy
Colposcopy with Biopsy and/or ECC
Biopsy interpretation
57452 I $ 102.21 1
57454
88305
143.83
102.38 $
7 246.21
*Colposcopy with loop electrode biopsy
Loop Biopsy interpretation and dissection
57460
88307
*Colposcopy with loop electrode conization
Loop Biopsy interpretation and dissection
Other Cervical diagnostic procedures
*Cone Biops
Conization of the cervix, cold knife or laser
57520
$ 289.65
Biopsy interpretation and dissection
88307
$ 201.51 '
$ 77.13 1
$ 124.38 1
y>+,
.
*Endometrial Biopsy
Endometrial sampling w/ or w/out ECC
57461
$ 297.59
201.51
35.90$
66.481
$ 77.131$ 124.381
$ 77.131$ 124.38
Biopsy interpretation and dissection
*LEEP/LOOP
Loop electrode excision
58100
88307 $ 201.51 ` $ 77.13 1 $ 124.38 1
$ 103.35
Loop Biopsy interpretation and dissection
57522 $ 245.85
88307 $ 201.51
$ 77.131$ 124.38 1
Additional allowable procedures - please submit these procedures quarterly to WWC Data Manger
Anesthesia for procedures
00400
Supplies & materials not usually provided
99070
# Maximum allowable reimbursement rate
Source: Centers for Medicare Services/Physician Fee Schedule, 2008:
*Preapproval from WWC required http://www.cros.hhs.gov/PFSlookup/02_PFSSearch.asp#TopOfPageMedicaid
•r .. �r
MEDICARE RATES AND CPT CODES - June 2008
Women's Wellness Connection
Reimbursable Procedures for Fiscal Year 06/30/2008 - 06/29/2009
Page 4
Procedure
CPT CODE
CO RATE
Professional
Component
Technical
Component
Due to Federal policy WWC cannot fund these procedures
CAD, diagnostic
77051
$ 14.68
$ 2.94
$ 11.74
CAD, screen
77052
$ 14.68
$ 2.94
$ 11.74
Cervical polypectomy
58558
$ 285.24
Diagnostic mammography digital, bilateral
G0204
$ 150.49
$ 41.51
$ 108.98
Diagnostic mammography digital, unilateral
G0206
$ 120.14
$ 33.23
$ 86.91
ductogram, multiple duct
77054
$ 125.73
$ 21.52
$ 104.21
ductogram, single duct
77053
$ 92.64
$ 17.32 $ 75.32
MRI, bilateral
77059
$ 970.79
$ 77.78
$ 893.01
MRI, unilateral
77058
$ 843.15
$ 77.78
$ 765.37
revised June 2008
# Maximum allowable reimbursement rate
Source: Centers for Medicare Services/Physician Fee Schedule, 2008:
`Preapproval from WWC required http://www.cros.hhs.gov/PFSiookup/02_PFSSearch.asp#TopOfPageMedicaid
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